Earlier today the Contra Costa Board of Supervisors voted 4-1 to authorize a new $1 million pilot program to extend primary health care services for an estimated 3,000 adult immigrants, including undocumented Contra Costa residents. The care will be provided through county-based clinics, serving approximately one-fifth of uninsured adults in need of the services.
The Contra Costa Cares program is a modest start, focusing on primary care rather than specialty care. Nonetheless it will provide real help for individual patients and real momentum for the notion that our health system is stronger when everyone is included. Under the program, enrollees would receive an insurance card and be assigned into a primary care medical home for care that includes immunizations, lab work, prescription drugs, and mental health counseling. This particular package of services is designed to reduce the need for care in emergency rooms and other expensive settings where care is typically provided, too little and too late (learn more here—the plan starts on p. 235).
The Supervisors needed three votes to pass the program but four to appropriate the funding, which they got for all parts of the proposal. One Supervisor balked at a portion of the staff recommendation regarding the administration of the program, and so that element did not pass and is being reviewed for further study.
In the discussion, there was concern from some Supervisors about the ongoing sustainability of the effort: the program will need to prove itself in terms of cost effectiveness over time and beyond the first year—or it may not be renewed. For this first year, beginning this November, funding responsibility for the pilot program will be shared equally between the county and a consortium of local hospitals. Other revenue streams may become available under state and federal changes in the near future to assist Contra Costa Cares’ efforts to coordinate care more effectively.
Contra Costa’s proposal is part of a statewide and county-by-county movement to extend care to the remaining uninsured and thus strengthen the health system for everyone. Just in the past year, 37 other counties have also refocused their safety-net services to extend some benefits to those excluded from existing health programs, including undocumented immigrants (see updated county map).
Today’s decision means that each of the three counties—Sacramento,Yolo, and now Contra Costa–that eliminated care to the undocumented in 2009 during the recession are now extending those services once again. With this action by Contra Costa, all three counties would now be returning to a more inclusive indigent care program for their residents—to the benefit of the entire community.
Contra Costa Cares demonstrates that each county can take meaningful steps to build a health care system that is responsive to the needs of all members of the community–and can build bridges to a statewide solution—including SB 4 which sits on the Governor’s desk and SB 10, next year’s effort to go further to cover all undocumented adults.